etiology,evaluation,traffic light diet plan,treatment

1. CHILDHOOD
OBESITY

2. DEFINITION
• BMI is the most widely used parameter to
define obesity.
• In children >2yrs,obesity is defined as BMI >/=
95th percentile.
• BMI between 85th-95th percentile falls in the
overweight range.
• Weight for height >120% is considered
obesity.

3. • It is a global public health problem sparing
only dramatically poor regions with chronic
food scarcity.
• Prevalence is 31% in age group of 2-6yrs,
16% in ages 6-19yrs.
PREVALENCE

4. ETIOLOGY
1.Environmental factors :
Increased consumption of high carbohydrate
beverages,fast food,
increased snacking between meals,
decline in levels of physical activity,
increase in sedentary activities,

5. high pressure for academic performance,
socioeconomic status,race,gender,
maternal education level,
parental obesity,
prenatal factors like weight gain during
pregnancy,high birth weight,gestational
diabetes,IUGR with early infant catch up growth,

6. chronic partial sleep loss
(1.>> hunger and appetite due to decreased
leptin levels and increased ghrelin levels,
2.decreased glucose tolerance and insulin
sensitivity due to alterations in glucocorticoids
levels,
3.synthesis of orexins,peptides in lateral
hypothalamus increasing feeding)

7. 2.Genetic causes :

9. 3.Endocrine causes :
• Monitoring of stored fats,control over
appetite,satiety occurs through
neuroendocrine feedback loops
• Linking adipose tissue,CNS and GI tract.

10. FROM THE GIT
Stimulating appetite Promoting satiety
Ghrelin Cholecystokinin
Glucagon like peptide-1
Peptide YY
FROM THE ADIPOCYTES
Adiponectin (>> levels in fasting,<< in obesity)
Leptin(= satiety,
low levels stimulate food intake,high levels inhibit
hunger)

11. FROM THE BRAIN
Neuropeptide Y
Agouti related peptide stimulate appetite
Orexin
Melanocortins
Alpha melanocortin stimulating hormone satiety

13. Endocrine causes
• Cushing syndrome (central
obesity,hirsutism,moon face,hypertension)
• Growth hormone deficiency (short
stature,slow linear growth)
• Hyperinsulinism (nesidioblastosis,pancreatic
adenoma,Mauriac syndrome)

14. • Hypothyroidism (short stature,weight
gain,constipation,cold intolerance)
• Pseudohypoparathyroidism (short
metacarpals,subcutaneous
calcifications,dysmorphic facies,MR,short
stature,hypocalcemia,hyperphosphatemia)

15. 4.CONSTITUTIONAL OBESITY
• No organic cause.
• Due to imbalance between energy intake and
expenditure.
• These children are tall for age ->
differentiating factor from pathological
obesity.
• Normal development,obesity is proportional.
• Unnecessary investigations to be avoided.

16. 5.HYPOTHALAMIC OBESITY
• Following
surgery,radiation,tumors,trauma,infection.
• Rapid onset obesity sets in.
6.DRUGS
• Anti epileptic drugs,steroids,estrogen,atypical
antipsychotics.

17. COMORBIDITIES
1.Type-2 diabetes (>> insulin resistance)
2.Hypertension
3.Hyperlipidemia
4.Non alcoholic fatty liver disease,cirrhosis
5.Risk of chronic inflammation (low levels of
adiponectin - anti-inflammatory peptide,
high levels of proinflammatory peptides IL-
6,TNF-a )

18. 6.Obstructive sleep apnea
7.Orthopedic complications like Blount
disease,slipped femoral capital epiphysis
8.Mental health problems like low self
esteem,depression,eating disorders
9.Metabolic syndrome
10.PCOS

19. EVALUATION
• Identified as a part of routine medical checkup.
• Perform detailed physical examination.
• Charting growth charts for weight,height,BMI.
• Consider possible medical causes for obesity
(poor linear growth,rapid changes in weight gain).
• Detailed history of family eating and activity
patterns
(description of regular meal,snacking,physical
and sedentary activities).

20. • Family history of adiposity and obesity related
disorders.
• Laboratory testing to identify comorbid
conditions.

25. INTERVENTION
• Nutritional advice + exercise + cognitive
behavioral therapy.
• Meals should be based on
fruits,vegetables,whole grains,lean meat,fish
and poultry.
• Gradual approach to cut down calories.
• Family support is crucial.

26. RECOMMENDED CALORIC INTAKE
DESIGNATED BY AGE AND GENDER

27. “TRAFFIC LIGHT” DIET PLAN
• Groups foods into those which can be
consumed without any limitation (green),
in moderation (yellow), reserved for
infrequent treats (red).
• Can be adapted to any ethnic group/regional
cuisine.

29. • Increasing physical activity contributes to
weight loss,decreases risk for cardiovascular
disease.
• Restriction of screen time to no more than
2hrs/day in children >2yrs old,no television for
children less than 2yrs (AAP).

30. • Pharmacological therapy :
Adjunctive,>> rate of weight loss

32. • Bariatric surgery :
For adolescents with a BMI >/= 40,
after attaining complete skeletal maturity,
suffering from medical problems associated with
obesity,
after they have failed 6 months of multidisciplinary
weight management program
(Roux-en-Y,adjustable gastric band)

33. PREVENTION
• Improved food choices+increased physical
activity+reduced screen time.
• Promotion of breast feeding(exclusive for 6
months,total BF for 12months).
• Introduction of infant foods at 6 months with
focus on cereals,fruits,vegetables.
• Introduction of lean meat,poultry,fish later in first
year of life.
• Avoiding highly sugared beverages and foods.

34. • Family approach , scheduled meals.
• Frequent snacking to be avoided.
• Limiting screen time for children.
• 60min/day of activity for children.
• Encourage walking to school.
• Use of mass media.

35. THANK YOU